Thursday, July 16, 2009

Rarely does a writer cover an issue as well as Hugh Anderson has written about Bill C-384, Francine Lalonde's private members bill that is scheduled for debate in September would legalize euthanasia and assisted suicide in Canada.

By HUGH ANDERSON, Freelance - Montreat Gazette & Vancouver Sun - July 10, 2009Wrapped in euphemisms and double-talk, another long step toward making it legal in Canada for doctors to deliberately end the life of patients in certain circumstances has been taken.

Bloc Québécois Francine Lalonde's private member's bill to accomplish that has received first reading in the House of Commons. It is likely within the next month or two to receive the standard one hour of debate by MPs at second reading, unless an election is called. A majority vote in favour could send her startlingly brief bill for study by a Commons committee.

Startlingly also, among those eligible to be legally killed by a doctor might be depressed 18-year-old teenagers who refuse their medications. A doctor would also no longer commit a crime by supplying a lethal dose to enable such depressed teenagers to kill themselves. That could be your grandchild if Lalonde's bill became law in its present form.

It's all a long way from what many people think of as a suitable case for euthanasia: an elderly person who is terminally ill and in excruciating pain who repeatedly and unmistakably asks for death. There is probably the support of most Canadians for exempting your doctor from a murder charge in that strictly limited case.

This kind of obfuscation is a striking characteristic of campaigners for the so-called "right to die with dignity," which in reality means making it legal for somebody else to kill you or to help you commit suicide.

After previous columns on the ominous implications for seniors, I received complaints from readers over using the word kill to describe euthanasia. But what else is it? The act may well be for compassionate motives, but it is what it is.

In her comments on this third attempt to legalize intended killing of patients, Lalonde claimed that experience shows that "abuses and the hypothetical slippery slope" have "not in any way become reality."

But consider the Netherlands, where so-called mercy killing has been formally legal since 2002 and factually legal for three decades. Several government reports have acknowledged that many people have been legally euthanized without their knowledge or consent.

In Oregon, state officials have conceded that they really don't know how many people have been prescribed a lethal dose of drugs to kill themselves, only those that have been reported by doctors.

Universally among existing and proposed euthanasia and assisted-suicide laws, what the legislation actually says is not at all what the supporters of it campaigned on, and what they said the safeguards would prevent. Lalonde's bill is no exception. Here are examples:

- The bill says any person age 18 or over who "appears to be lucid" and who has tried or refused available treatments and "continues to experience severe physical or mental pain without any prospect of relief" would be eligible to be assisted to commit suicide if the rules are followed. Note that "mental pain." Seniors who have lived through periods of deep depression will recall that at the time there seemed to be no prospect of relief.

- The bill says that certifying the person is suffering such pain or is terminally ill would be up to medical practitioners, defined as "a person duly qualified by provincial law to practise medicine." Does this include my dermatologist, my podiatrist? For "mental pain," there should surely be a requirement to consult a psychiatrist?

- The bill's wording means that people living with disabilities or with chronic conditions would be vulnerable. Such sufferers can be considered by others, and often are, as having no prospect of relief and wishing to die. The sufferers themselves may well have a different opinion.

- The bill's wording would allow you to be killed legally when you have become incompetent to make the choice, if you had earlier given written authority while you appeared to be lucid to another person to act on your behalf when you no longer appear to be lucid. Better be careful about the wording of your mandate or advance directive.

- The bill's wording has no definition of terminal illness. A diagnosis could become an immediate death warrant, no matter what your chances of survival might be or if the diagnosis is wrong.

- The bill's restriction of eligibility based on age would probably be ruled unconstitutional if it became law and was legally tested. As in the Netherlands - where it is now legal for doctors to kill infants, if parents agree, if they believe their patients' suffering is intolerable or incurable- this might mean that eventually babies could become eligible.

The interesting thing about the article (article follows my comment) is that Dr. Yves Robert from the Quebec College of Physicians only refers to the use of analgesics that may result in the death of the patient. It is not euthanasia if the physician intends to control the pain and not kill the patient.

There are approved guidelines that a physician follows to determine the increases in analgesics. If the physician follows the guidelines (within reason) then the physician has nothing to worry about.

It is euthanasia if the physician just gives the patient a lethal dose of analgesic with the intention of causing the patients death. Intention is difficult to prove but if the physician simply gives the patient a lethal dose of analgesic without attempting to follow the guidelines then the physician should be charged with euthanasia.

If the Quebec College of Physicians allows physicians to lethally inject their patients with overdoses (turning a blind eye to the approved protocols for analgesic use) they will be erasing the distinction between caring for people and killing people. People will lose faith in the ethics of their physician and they will fear entering palliative care because the lines between caring and killing will be blurred.

The other possibility is that the Quebec College of Physicians will allow lethal doses (non-palliative) of barbituates to be injected into patients when they are experiencing particularly painful symptoms. If this is their intention then they are in fact wanting to legalize euthanasia through the back-door.

In other words, the Quebec College is using their concern for physicians who need to use large doses of analgesics as the straw man arguement in order to allow them to give Quebec physicians the right to directly and intentionally cause the death of their patients by lethal injection.

We should not be surprised that the timing of the Quebec College of Physicians decision will take place at approximately the same time as Bill C-384 goes to a Second Reading vote.

The Euthanasia Prevention Coalition needs your help. Please become a member by joining online by paypal on our website at: www.euthanasiaprevention.on.ca

With great caution, the Quebec College of Physicians is prepared to cross the line on the controversial debate over euthanasia and propose that it be included “as part of the appropriate care in certain particular circumstances.”

After examining the issue for three years, the College's task force on ethics concluded that Quebec society has evolved to the point where it could tolerate euthanasia in specific circumstances. The task force's recommendation will likely be part of a “reflection” document the College will release next fall, hoping that a public debate on the issue will pressure the federal government to eventually amend the criminal code.

“We are being very cautious in our approach,” said the College's secretary, Yves Robert. “Avoiding the debate contributes to the general hypocrisy around this issue. To say that it doesn't happen because it is illegal is completely stupid. … We have to stop hiding our head in the sand,” Dr. Robert said.

It is common knowledge that physicians often have no choice but to constantly increase medication such as morphine to alleviate the pain and suffering of terminally ill patients.

Sometimes, the pain is so unbearable that the amount of painkillers or analgesics used to control it can be fatal. And this, according to the Quebec College of Physicians, can be viewed as a form of euthanasia.

“The question here is to decide whether a drop in dosage or an increase in dosage constitutes a criminal act,” Dr. Robert said. “We may go as far as to recommend that in certain cases, where the pain is unbearable, the amount of analgesic required could correspond to a form of euthanasia.”

The College wants to avoid a divisive confrontation between those who are for or against euthanasia, saying such a debate would solve nothing. Instead, the debate should be about the doctor's role in accompanying a terminally ill patient toward the inevitability of death, offering as much dignity and medical assistance as possible. “There's not a politician or a lawyer that can tell me what that entails,” Dr. Robert said.

The College says there are three conditions required in order to amend the criminal code, which currently defines euthanasia as a criminal act. The first would require that the decision be made in accordance with the patient's will. A physician alone could not decide, Dr. Robert said. The second condition would require that clear rules be established to protect society from abuses. And thirdly, the doctor has to be part of the decision-making process and not someone who simply carries out orders.

Quebec physicians are adamant in stating their position excludes assisted suicides, which is practised in Switzerland and in some parts of the United States. There have been a few rare cases where Canadians have died at the assisted-suicide clinic Dignitas in Switzerland, but the College opposes the practice.

Right-to-die groups in Quebec believe the province's College of Physicians has taken a “bold, cautious and realistic” approach that will have considerable impact on the rest of the country.

Social worker Yvon Bureau, who has spent 25 years promoting the right to euthanasia, called the College's proposal a major step forward.

“I believe this is huge,” Mr. Bureau said. “We need to avoid having people commit suicide or die under terrible circumstances. About 80 per cent of the Quebec population supports the right to medical assistance in dying. All of this would take place in the course of the relationship between the doctor and the patient, as well as the family.”

Mr. Bureau hopes the debate will persuade the Quebec government to adopt an “end of life” policy that will recognize each individual's right to die with dignity. However, he anticipates strong opposition from groups that fear that such a policy may lead to abuses.

The College of Physicians is expected to table its final proposal in November.

Wednesday, July 15, 2009

Rarely do you read two articles published on the same day that promote an opposite point of view. Today (July 15, 2009) those two articles came up in my inbox, one from the UK and one from America.

The first article was written by Barbara Coombs Lee who is the leader of the Compassion & Choices suicide lobby group in America. Her article - Healthcare Reform and the Price of Torture
promotes a pessimistic point of view about life, one that would lead one to consider death as preferable to growing old, living with disability or living with chronic or life-limiting medical conditions.

The second article was written by Baroness Finlay, an independent member of the House of Lords in the UK and a Professor of Palliative Medicine at the University of Cardiff who wrote an article titled - Don’t fear death. Enjoy the setting sun.

My first reaction to the Coombs Lee article was how the concept of Choice with connection to euthanasia and assisted suicide is an illusion. The suicide lobby wants you to believe that legalizing euthanasia or assisted suicide would grant choice and freedom for people to have their life ended based solely on autonomous decisions for competent people.

For instance Coombs Lee states:

"Standard routine is to torture those in the process of dying by inflicting upon them a host of toxic chemicals, invasive machinery and painful surgeries. It's the American way of dying --- agonized and prolonged imprisonment in an intensive care unit, pinned down under a maze of tubes and machines, enduring one medical procedure after another, unable to hold or be held by loved ones."

If end-of-life care in America is based on torturing people who are dying, then it is far more reasonable to find your nearest veterinarian and be "put to sleep."

Coombs Lee continues by stating:

Oncologists entice their dying patients into bearing one more, experimental round of chemotherapy almost certain to intensify toxic symptoms without extending life. Surgeons repair the fractures and amputate the limbs of people clearly only a few weeks from death. The newest medical specialists, "hospital intensivists" deftly thread tubes into failing hearts and attach ventilators to decrepit lungs. Much of the pain they inflict does nothing but monitor the chemistry and pressures of internal crevices and gather the information necessary to thwart a body trying to shut itself down.

Coombs Lee seems to view physicians as the enemy. She describes them as being primarily concerned about invoking extra-ordinary burdensome interventions with no hope of benefit. With Coombs Lee description of care one would have to conclude that physicians are no better than sadistic warriors from another time.

But Coombs Lee has the answer for medical care in America. She is suggesting that health care reform can end the torture by promoting assisted suicide. She states:

“Like all cultural shifts, it must start with the people. The people --- you --- deserve to be able to choose a healthcare plan driven by what patients need, not what profit demands. You deserve a system that pays your doctor to talk with you about peaceful endings when death is imminent. One that pays for hospice care in the home as readily as it pays for intensive care in the hospital.

“Raise your voice. Make your views known. Talk to your own doctor and to your family. Take action with calls to members of Congress and letters to local news outlets. Ask for healthcare reform to include payment for your doctor to talk to you about your end-of-life wishes. We make it easy for you. Tell them you reject torture at the end of life for yourself and you resent the needless torture of others. Joining together, let's change the American way of dying.”

Notice how Coombs Lee never mentions that she is actually promoting assisted suicide. If she were truly concerned with caring for people who would otherwise be tortured, she would clearly state that she is lobbying government to legalize assisted suicide.

She also doesn’t tell you what assisted suicide is. Assisted Suicide isn’t about choice, or freedom or autonomy, it is giving physicians the right to be directly and intentionally involved with causing my death.

Coombs Lee is saying that the way to get healthcare reform in America is by legalizing assisted suicide. She does say:

"You deserve a system that pays your doctor to talk with you about peaceful endings when death is imminent"

Doctors can already speak to you about end-of-life options, but they cannot speak to you about assisted suicide (directly and intentionally causing your death).

How does giving physicians the right to be directly and involved with causing your death give you choice. It only gives your physician more choice.

Baroness Finlay presents a positive view of life, of aging gracefully and dying with real dignity. She starts her article by stating:

“So why are we increasingly fearful of growing old? People can consider longer working lives to contribute actively to society, precisely because health is better than ever. They can share their wisdom, accrued over years, with others. The trick in being an inspirational older person is perhaps in attitude rather than in physical performance. Of course, none of us wants to be a burden or to feel lonely. However, the future for our connectedness with others, maintaining our role in life and independent living, has never been greater.”

Notice the difference in attitude. Finlay recognizes that life is improving for the elderly whereas Coombs Lee presents life as a type of trap.

Finlay continues by stating:

After spending much of my life treating people who are very seriously ill and dying, I have come to be in awe of death and to realise the amazing uncertainties of life. I have been privileged to be part of a revolution — it’s nothing short of that — in the way that people are treated.

Finlay then extols her experience with the current medical system by stating.

It is paradoxical that, at the same time as we have seen ground-breaking advances in the treatment of serious illness, we see increasingly strident demands for euthanasia. The pressure seems to come from fear of tomorrow rather than from the reality of today. Those who commend euthanasia usually frame their proposals around terminal or chronic illness. But in reality they base their case on personal wish alone and see assisted suicide as another “end of life choice”.

She then explains why the attitude and philosophy of Coombs Lee would not create new choices but in fact exploit people in their most vulnerable condition and eliminate end-of-life choice. She states:

Their demands assume that everyone who is seriously ill can say without difficulty whether they want to be cared for or to end their lives and that no one ever comes under pressure to “do the decent thing”. The real world isn’t like that. Among the thousands of seriously ill patients I have treated, the vast majority are vulnerable to influence. Most people getting old are aware that death is approaching; they want to talk about dying. They often seek reassurance that they are still of value and worth, that they can contribute to society. Very few wanting to talk about dying actually want to die.

Finlay concludes her comments by stating:

We should remember that what we read in the papers and see on TV, whether it is a death from swine flu or a suicide in Switzerland, is the exception rather than the norm — it wouldn’t be news otherwise. And, when we feel inclined to pessimism about the future, we should reflect on what earlier generations had to cope with and ask ourselves how much of our gloom stems from our own changing expectations.

She ended her article with these comments:

It is great to able to grow old. So perhaps we should enjoy the glory of the setting sun.

I choose to follow the direction of Finlay over Coombs Lee. Finlay is about caring for people until they die with dignity whereas Coombs Lee wants us to fear death and give physicians the right to directly and intentionally cause your death.

Tuesday, July 14, 2009

The media are in an uproar about the sad suicide death of a British conductor and his wife at the Dignitas Clinic.

Last week the House of Lords in the UK voted down a proposal by Lord Falconer that would have made death tourism a right for citizens of the UK.

Dr Peter Saunders, the director of the Care Not Killing Alliance in the UK stated to the BBC News that:

"The current law is clear and right and the House of Lords were wise not to approve any change to it."

He further stated that:

"With imminent health cuts, growing numbers of elderly people and increasing levels of elder abuse the very last thing we need is to put vulnerable people, many of whom already think they are a financial or emotional burden to relatives, carers and the state, under pressure to end their lives through a change in the law."

People need to understand that the Dignitas clinic views euthanasia and assisted suicide as a human right. We understand that Joan had cancer, but we do not know whether she was terminally ill. It appears though that Edward was not dying but experiencing symptoms related to old age.

I am concerned when the media creates a push for elderly people to view their lives as not worth living. People should be treated with dignity and not pressured to end their lives.

This case should be viewed for what it is, another tragic case of a couple who have killed themselves in difficult circumstances.

New Threats in Canada
Canadians need to understand that Bill C-384, the private members bill in the Canadian parliament that would legalize euthanasia and assisted suicide in Canada, would allow for death clinics to operate in Canada.

The bill would allow euthanasia and assisted suicide and would allow death by lethal injection.

The bill does not limit euthanasia and assisted suicide to terminally ill persons but rather allows the direct and intentional killing of people who are suffering physical or mental pain.

The bill doe not limit euthanasia and assisted suicide to Canadian citizens and would therefore allow Canada to become a destination for death tourism.

The bill does not define terminal illness.

The bill bases mental capacity on whether or not a person "appears to be lucid."

Canadians need to defeat Bill C-384 or we will become the next Switzerland.

Wednesday, July 8, 2009

The Care Not Killing Alliance has welcomed the House of Lords decision to reject, by 194 votes to 141, Lord Falconer's amendment (173) to the Coroners and Justice Bill which would have exempted from investigation and prosecution those who help terminally ill people to travel abroad to seek assisted suicide in countries where such actions are legal – in effect, Switzerland.

Care Not Killing Director Dr Peter Saunders said, 'The House of Lords has wisely rejected this amendment. Today we have seen over 30 leaders of disabled people's organisations in an open letter, along with doctors' leaders in a comprehensive clinical briefing joining their voices to those of senior legal figures who last week labeled the amendment “ill-defined, unsound and unnecessary”.'

'The amendment is vaguely worded and unworkable and its safeguards illusory. The phrase “terminally ill” is not further defined and could apply to people with a very wide range of chronic progressive illnesses some with life expectancy stretching to decades. The assessing doctors are not required to know, to see nor to examine the person in question nor even to review the case notes; nor to possess the requisite training, experience and skill necessary to make a sound judgement about prognosis and capacity. The amendment is thereby wide open to manipulation and abuse.'

'Lord Falconer's amendment would have put vulnerable people at risk. At a time of economic recession with imminent health cuts, growing numbers of elderly people, and increasing levels of elder abuse the very last thing we need is to put elderly, sick or disabled people, many of whom already believe they are a financial or emotional burden to relatives, carers and the state, under pressure to end their lives through a change in the law.'

'The current law is clear and right. The Suicide Act 1961 has stood the test of time and gives a blanket prohibition to all assistance with suicide. The penalties the current law holds in reserve give it both a stern face to deter would-be abusers and a kind heart to enable judges to exercise compassion in hard cases. This amendment would have created legal confusion by loosening a law that the government is actually trying to tighten to stop internet suicides. What is not broken does not need fixing'

'Passing the Falconer amendment would have irreparably damaged the law by establishing an exception to the Suicide Act. The next step in the incremental strategy would have been to argue for 'equality' by legalising assisted suicide here. The House of Lords has wisely rejected it.'

- to promote more and better palliative care; - to ensure that existing laws against euthanasia and assisted suicide are not weakened or repealed during the lifetime of the current Parliament; - to inform public opinion further against any weakening of the law.

We seek to attract the broadest support among health care professionals, allied health services and others opposed to euthanasia by campaigning on the basis of powerful arguments underpinned by the latest, well-researched and credible evidence.

Key groups signed up to Care Not Killing include: The Association for Palliative Medicine, the United Kingdom Disabled People's Council, RADAR, the Christian Medical Fellowship, the Catholic Bishops Conference of England and Wales, the Church of England and the Medical Ethics Alliance.

Tuesday, July 7, 2009

I just received a notice from Peter Saunders, the director of the Care Not Killing Alliance in the UK that the assisted suicide amendment in the UK parliament was defeated.

He stated:

Falconer's amendment just defeated by 194 to 141 - a bigger margin than the defeat of the Joffe Bill!!

A fantastic result!

Well done all!

Peter Saunders

This is an incredible victory considering the fact that the amendment to the bill was based on giving UK citizens the green light to travel to Switzerland to temporarily visit the death clinic without any worry of legal reprisal.

The reason the assisted suicide law is being changed in the UK is to ensure that predators who counsel others via the internet to commit suicide can be prosecuted for their crime. Falconer's amendment would have given the UK a crazy dichotomy within their legislation. It would have outlawed assisting a suicide and also allowed death tourism.